Arthritis (degenerative joint disease) is extremely common in older pets, especially the larger breeds. It is the number one cause of chronic pain in dogs and cats. It can affect any joint, but the hips, shoulders and back are most common. The condition is the result of long-term stresses on a joint, either resulting from an old injury or from natural development of a poorly conformed joint. It occurs when cartilage in the joint is damaged. Cartilage decreases joint stress by acting like a gelatinous shock absorber. When cartilage is damaged, inflammatory changes occur which eventually lead to destruction of the cartilage and subsequent damage to the underlying bone.
Arthritis is often progressive, becoming worse over time – sometimes quickly but usually slowly and gradually. It may start as intermittent, occasional sore days, in colder weather or with strenuous exercise. As arthritis progresses, the lameness and stiffness become more frequent and is usually worst when your pet first gets up after lying down but gets a little better as he or she moves around.
Other symptoms include:
reluctance to walk, climb stairs
jump or play
difficulty rising from a resting position
lagging behind on walks
soreness when touched
yelping or whimpering in pain
acting aggressive or withdrawn or other personality changes.
What Can You Do About It? – Treatment Options
While surgery may be able to help in some situations, most of the time the degeneration of the joint cannot be reversed and treatment focuses on preventing/slowing progression of damage. What we do know is that arthritis pain is best addressed by what is called a multi-modal approach, meaning that several approaches combined yield better results than any single therapy.
Numerous products are available; some are best combined with others and some cannot be combined.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Most pets with arthritis pain need relief now, not in 1 to 2 months when the cartilage building blocks and nutritional anti-inflammatories have had a chance to build up.
These medications act quickly by suppressing the inflammatory biochemicals (prostaglandins) that ultimately lead not only to the pain of arthritis but also to cartilage damage. None of these medications can safely be combined with one another. Furthermore, human NSAIDs tend to be toxic to pets, especially cats. Never use a human medication of any kind in a pet without specific instructions on how to do so from your vet.
Some common NSAIDs that are available for pets:
Modern NSAIDs distinguish between “good” prostaglandins that help promote kidney circulation and intestinal health and “bad” ones that cause pain and damage. Still, it is important to realize that classifying prostaglandins as “good” and “bad” is an oversimplification.
Pre-treatment screening blood tests are still important before using an NSAID as a pre-existing kidney or liver condition may preclude their use. Monitoring tests typically are recommended every six months for pets on NSAIDs.
If a pet has or comes to develop a condition that is not compatible with NSAID use, one of the analgesics listed below would be a fair alternative.
It is important to mention that cats are uniquely sensitive to all NSAIDs and it is tricky to find one that is appropriate. Of the list presented here, only meloxicam (Metacam) is appropriate for long-term feline use and only with some dose modification.
Analgesics that are not Anti-inflammatory
Sometimes the combination of a cartilage-protecting agent and an anti-inflammatory drug is not adequate for pain control. There are several appropriate pain relievers that can be used in pets. These medications are strictly analgesics and do not modify the inflammation in the joint.
Tramadol is a narcotic pain reliever similar in many ways to codeine. The pill size makes it a bit tricky for feline use.
Amantadine is an antiviral medication found to relieve chronic pain.
Gabapentin, originally an anti-seizure drug, has been found to have effects on chronic pain especially pain from pinched or inflamed nerves.
The medications can be used in cats and dogs alike and are compatible with all other the other medications listed. A synergism occurs when these medications are combined with NSAIDs such that the combination of both drugs produces greater results than one would expect.
Cartrophen Vet Injections
This treatment does not fit readily into the fast and slow classification system proposed.
Cartrophen Vet protects and supports the recovery of joint cartilage and slows down the disease development. Cartrophen Vet relieves pain and lameness by actually treating the disease.
Cartilage is strengthened and protected as Cartrophen Vet stimulates the production of the “building blocks” for cartilage (chondrocytes). This improves the integrity of the cartilage and cushioning of the joint surfaces.
Cartrophen Vet stimulates the production of Hyaluronic Acid (HA) increasing the quantity and quality (viscosity) of synovial (joint) fluid, thereby dramatically improving the lubrication of the joint surfaces.
By increasing the blood supply to the subchondral bone Cartrophen Vet reduces the pain associated with OA and also increases nutrition to the joint.
Cartrophen Vet is a potent anti-inflammatory and has equal efficacy to the leading NSAIDs in treating the symptoms of arthritis, with minimal side effects.
It is classified as a disease modifying osteoarthritis drug (DMOAD) and represents the rational approach to the medical treatment of osteoarthritis in dogs
Cartrophen Vet is best given as a series of injections, once a week or so for 4 injections. After an effect is seen, Cartrophen injections are given on an as needed basis.
Slow-acting drugs for arthritis ultimately improve joint function and help with pain relief, but they require a time frame of weeks to months to exert their effect. They may have disease-modifying properties such that their benefit continues even after their use has been curtailed. These products are typically what are called neutraceuticals, meaning that they are nutritional supplements that have medicinal properties. Most arthritis patients can benefit from their use and they are considered a basic starting level for joint care.
Because these medicines as classified as neutraceuticals, (i.e. nutrients with medicinal properties) rather than as drugs, the usual rigorous testing for efficacy has not been required. As a result, the optimal dosage has not been determined and almost every product has a different dose recommendation. Some experimentation may be necessary.
These products often complement treatment with anti-inflammatory medications.
Glucosamine Hydrochloride and Chondrointin Sulphate
These products are cartilage components harvested chiefly from sea mollusks (i.e., cartilage is made up of chondroitin sulfate and glucosamine metabolites, among other things). They provide the building blocks needed to repair damaged cartilage. It is also felt that these products may have some anti-inflammatory properties separate from their structural uses
Omega Three Fatty Acids
Certain dietary fats, typically cold water fish oils, have been found to have anti-inflammatory properties. While this finding has primarily been used in the treatment of itchy skin, many arthritic dogs and cats have also benefited from supplementation. While there are no toxic issues to be concerned with, these products require at least one month to build up to adequate amounts. The appropriate dose is still somewhat controversial but the ratio of EPA (eicosapentenoic acid) to DHA (docosahexenoic acid) should be 3:2.
MSM stands for methyl sulfonyl methane and represents another nutraceutical anti-inflammatory agent. The glycosaminoglycans that enable cartilage to soak up water and thus act as a cushion for articulating bones are all sulfates. The idea is to provide nutritional building blocks for cartilage repair. Beyond this, MSM seems to have anti-inflammatory properties and may act as an anti-oxidant (see below).
Anti-oxidants and Free Radical Scavengers
Free radicals are harmful biochemicals that can attack us from external sources (such as pollution, sunlight, etc.) or we make them ourselves as by-products of oxygen use. These harmful little molecules are highly reactive and attack our structural proteins as well as cause production of assorted inflammatory proteins. The theory is that free radicals cause damage to our brains, skin, joints etc.
Anti-oxidants that are readily available include Vitamin C, Vitamin E, SAMe, Superoxide Dismutase (S.O.D.) and others. Oxtrin® and Comfort Tabs ® (S.O.D.) are marketed for joint support. Denosyl (SAMe) is marketed for animals primarily for its effects in the liver, though in humans its joint-related results are a primary focus.
Important Non-Medical Therapies
Although the arthritic pet has a large menu of medications to select from and while proper medication is an important part of therapy, weight control and proper exercise should not be forgotten.
Proper exercise is excellent physical therapy for the arthritic pet, as it is crucial to maintain as much muscle mass as possible to support the abnormal joint. Arthritic dogs need regular, gentle exercise. Short walks are best. Over-exertion, as with fetching, Frisbee tossing or running, can sometimes aggravate arthritis; slower exercise or swimming is very beneficial. Two 15 minute sessions are generally better than one 30 minute one.
Massage and gentle flexion/extension of the joint may also help.
Do not over-do on cold or hot days, as older pets are less tolerant of temperature extremes.
Remember, treatment for joint disease is likely to involve a combination of medications in addition to physical activity.
Being overweight places excess stress on joints and decreases exercise tolerance. A decrease in exercise then leads to reduced muscle mass and hence more stress on joints. If your pet wants to stop, don’t force him to keep going. Some older pets are like older people – they don’t want to admit they can’t do the things they did in their youth.
To control being overweight, ask us for specific feeding recommendations and a weight control plan. Older, inactive pets may only need half the calories they did when they were younger. Feeding appropriately and reducing weight increases activity. More exercise combined with less weight to carry around can reduce arthritis symptoms dramatically.
Arthritic dogs are most stiff when they lay around, especially on cold surfaces. Encourage your pet to sleep on a bed or blanket and not on the cold, hard floor or ground. Orthopaedic beds are available through pet supply catalogs and larger pet stores. These can be extremely beneficial to stiff, sore pets.
Arthritis gradually worsens with time. Other diseases may progress at varying speeds and more than one may be present at a time. Your pet’s activity level and medications will need to be adjusted as the months pass. Keep in close contact with us so we can keep your pet as healthy and pain free as possible.
There are several other diseases and conditions that cause symptoms similar to arthritis, including intervertebral disc disease, spondylosis, ligament tears, and discospondylitis. It may be necessary to have x-rays done to be sure arthritis is really the problem. Other diseases require different treatment than arthritis. Discospondylitis, an infection of the bones of the spine, progresses quickly, causing irreversible damage in a short period of time. Early diagnosis is important if proper treatment is to be effective. If your dog hurts, we need to find out what’s wrong as soon as possible.
Signs of osteoarthritis may be subtle and easy to miss
Early treatment is critical to slow progression of the disease
Maintaining lean body weight is absolutely critical for arthritic patients
Newer concepts of arthritis management involve proper exercise to maintain muscle mass and decrease pain
Structure-modifying agents are most effective when started early and maintained long term
Non-steroidal anti-inflammatory and analgesic drugs, acupuncture, and physical therapy may be recommended especially for later stages of the disease
Animals don’t necessarily moan, whimper or stop eating until the pain is intolerable. There is no need for your pet to suffer from untreated arthritis.